Ischemic electrocardiogram during pharmacologic stress with regadenoson

Excerpt

90 year old male with a history of coronary artery disease, hyperlipidemia, peripheral vascular disease, and moderate aortic stenosis was referred for stress testing after being seen in clinic with recurrent left-sided exertional chest pain, relieved with rest and not associated with any other symptoms. His cardiac history was also significant for a remote non-ST elevation myocardial infarction in the setting of an acute gastrointestinal bleed. His work-up in the past included coronary angiography 20 years prior to his presentation which had demonstrated non-occlusive diffuse two-vessel coronary artery disease. Aortic valve area measured 1.1 cm² on an echocardiogram approximately 1 year prior. His medications included aspirin, metoprolol, omeprazole, pravastatin, tamsulosin, and acetaminophen as needed. Severe osteoarthritis of his back and knees precluded exercise stress testing and he therefore underwent vasodilator stress using regadenoson with planned SPECT myocardial perfusion imaging. His baseline ECG is normal (Figure 1A).

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